Kenneth Bermudez, MD, is a board-certified plastic surgeon with more than 20 years of experience. He is committed to helping his San Francisco cosmetic and reconstructive surgery patients achieve — and often exceed — their cosmetic goals.

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Tuberous breast deformity (or TBD) is a congenital deformity of the breast which can occur in both men and women. It is most likely apparent during puberty when the development of the breast compared. The exact etiology of this congenital abnormality is unclear, but it is thought to be of embryologic origin. Most reports suggest that the superficial investing fascia of the breast is abnormal and constricted at the base of the breast. This constriction at the base of the breast is responsible for the reduced width or base diameter.
Fertility is not affected by this condition.
Tuberous breast can also be referred to as a “constricted breast”, but tuberous is more descriptive.
Tuberous breasts are not just a small breasts, rather atypically include abnormalities such as an enlarged, puffy (due to herniation of breast tissue) nipple areolar complex, a high breast fold (inframammary fold), unusually wide intermammary distance (increased sternal width), lack of breast tissue and a narrow base at the chest wall.
There can be a wide range of these symptoms with some patients having very mild disease, and others having severe deformity. The condition can affect the ability of I woman to breast feed because of lack of development of the breast gland/breast ducts.
If you suffer from tuberous breasts, contact Dr. Bermudez today for breast augmentation in San Francisco. He can provide an evaluation, and surgical correction for your breasts.

6 Scientific Differences between Blondes and Brunettes
Here are six little-known differences between blondes and brunettes, from the latest scientific literature:
1. On average, blondes take longer to get ready.
A study conducted in 2009 (with over 3000 participants) found that blondes take 6 minutes longer than their darker-haired counterparts to get ready. Blondes will spend an average of 72 minutes a day on their beauty routine compared to 66 minutes for brunettes.
2. Natural blondes have more hair than natural brunettes.
Natural blondes have approximately 120,000-147,000 hairs, while brunettes have 100,000-120,000. This makes perfect sense, as evolutionary biology tells us that hair evolved partially to protect the scalp from potentially damaging UV rays. As darker hair contains more of the pigment melanin, it naturally provides more of a protective barrier, and hence brunettes needed less hair to serve the same purpose.
3. A man’s preference in a woman’s hair color stems from his own hair color – and life experience.
Although some reports state that Caucasian men generally prefer fair-haired women, an interesting review noted research that brunette men preferred brunette women; blonde men equally preferred blondes and brunettes; and blonde, brunette, and red-headed women all preferred dark-haired men.
Furthermore, research has shown that both men and women are attracted to certain partners based on their intrapersonal interactions with others; that is, if you always had brown-haired friends growing up, but a blonde-haired bully picked on you constantly, you are more likely to stick to brown-haired partners later in life. This gets into a whole lot of psychological and sociological research that is outside of my realm
4. Blonde waitresses (restaurant servers) earn better tips.
Despite their perceived level of overall attractiveness, blonde waitresses receive higher tips than darker-haired waitresses. In a 2009 survey of 482 waitresses conducted by Cornell University, blondes earned significant higher tips than their brunette counterparts, despite their reported levels of “sexiness”. What ever happened to 15% for standard service and 20% for good service for all? Hm. Moving on
5. Brunettes are perceived upon first meeting to be more intelligent.
Research has shown that raters perceive women with dark hair to be more intelligent at a first meeting, The reason for the bias is unknown, but I speculate that it is due to the simple fact that women dye their hair blonde more than any other color. Not only does this mean that there are more blondes than brunettes after a certain age, but this also means that women who spend extra time focused on beauty and their appearance are more likely to be blonde. With that said, there are many incredibly smart blondes out there
6. When women dye their hair lighter, they feel more fun.
True – when women dye their hair lighter, they have been proven to go out more (3 nights/week for blondes versus 2 for brunettes) and to feel more confident and youthful. Why this phenomenon exists is unknown. Part may be due to societal influences, as the majority of the Hollywood celebrities are blonde. Another theory is that many Caucasian women are born with hair that darkens with age, and so dyeing their hair reverts them to their youth. One additional possibility is that blonde hair is somewhat more forgiving of skin imperfections, which is why most women choose to lighten their hair as they get older.
Although all of the aforementioned information is provided by scientific literature, the bottom line is that this article is just for fun. There are many beautiful and intelligent women who are both blonde and brunette. While each hair color may impart some of its own minor advantages upon a first meeting, the truth of the matter is that, over time, most of these perceived advantages will give way to the time-tested traits of its wearer, like excellent character, honesty, integrity and benevolence.

A recent article in the New York Times highlights the increasing popularity of plastic surgery in men. The article suggests substituting the traditional Father's Day gifts for cosmetic treatment and surgery. Things like chin implants, botulinum toxin (Botox and dysport), facial fillers, liposuction, and other appearance improving treatments have rised in popularity not only over the last 10 years, but especially during Father's Day.
It is no longer "taboo" for men to seek plastic surgery and this article highlights the fact that men generally are having more cosmetic procedures and treatments. According to the areas ASPS statistics, roughly 10% of all cosmetic procedures were performed in men in 2012 which is up from about 8% in 2010.
Take a look at the article, it's very enjoyable and informative:
http://bucks.blogs.nytimes.com/2013/06/10/happy-fathers-day-and-lose-those-love-handles/
Happy Father's Day!

Amazing story!
In Poland, 33-year-old man received a life-saving face transplant 3 weeks after being injured at work.
Face transplant scar incredibly complicated and rare procedures that usually will are extensive preparation.
From what we understand, this patient's condition was extreme and his life was at risk due to the inability of eating, breathing and open wounds.
The patient worked as a stone mason and suffered a machine injury which severely damaged his upper jaw and face. An attempted replant of his own face failed and therefore, he was taken to the Cancer Center and Instituted of Oncology in Gliwice, Poland, where a 27 hour face and bone transplant was performed on May 15.
Surgery reconstructed his facial skeleton, as well as his palate, soft tissues, and lips. The donor was also a young man, but required appropriate matching prior to the transplant.
The doctors performing the surgery stated that this was the only shot that the patient had surviving his injuries. They assume the patient will return to normal life. He will require immunosuppressive drugs for the rest of his life in order to keep his body from injecting the donated facial tissue.

After a brief hiatus from the FDA review, we have finally received approval to start the BRAVA with AFT.
Food and Drug Administration (FDA) has completed its review of our investigational device exemption (IDE) application for the referenced clinical study. The FDA has determined that “there are no subject protection concerns that preclude initiation of the investigation” and has approved Brava.
In essence, we have been given permission to resume the referenced study. Furthermore, the FDA categorized the Brava device as a “CMS Reimbursement Category B1” type. A category B1 designation now allows the device to obtain insurance reimbursement via the Centers for Medicare and Medicaid Services (CMS) and presumably, by private insurers as well, on a going forward basis, so long as they are participants of the current clinical trials.
Both reconstructive breast surgery patients and patients who want regular breast augmentation surgery will be candidates for this treatment. We are ready to start evaluating patients and performing this ground breaking procedure.
Please call our office for an appointment. 415-668-2122.

If I were to pick one question that I get asked over and over again, it would be about stretch marks. Stretch marks are a form of scarring of the skin. It's caused by stretching or tearing of the dermis (the intermediate layer of your skin, not visible externally, that helps your skin retain its shape). They are a result of tearing and stretching of the skin associated with rapid growth or weight changes. stretch marks can also be influenced by hormonal changes associated with pregnancy, puberty, bodybuilding and hormone replacement therapy.
Initially the stretch marks appear as reddish or purple lines, but will eventually faded to a lighter color depending on the skin type. Stretch marks can appear anywhere in the body, but more commonly occur in places were large amounts of fat are stored (abdomen, breasts, upper arms, thighs and buttocks). They pose no health risk, and did not compromise the body stability to function normally.
They're have been a few things that promote stretch marks. High body mass index, low maternal age, weight gain over 30 pounds and higher birth weight were independently associated with the occurrence of stretch marks in a few studies. Additionally, teenagers are at the highest risk of developing severe stretch marks.
75-90% woman developed stretch marks to some degree during pregnancy. Elevated hormonal levels during pregnancy will cause stretch marks to appear around the sixth or seventh month of pregnancy. This is also one the skin tends to be subjected to higher levels of stretching forces. A German research team tested the application of massaging and cream and found that only one third of women with this treatment developed stretch marks while two thirds of the untreated controlled group developed stretch marks. Unfortunately, it was not clear from the paper that this was a double-blind study.
A few other studies found that the daily application of vitamin E oil was associated with less severe stretch marks during pregnancy. During pregnancy, do recommend that woman daily skin moisturized in order to prevent itchiness from the dry, and stretch skin. It may also be preventative in regards to decrease in the amount of stretch marks.
It seems that every month or so I get a new advertisement for some type of cream or laser or therapy for the improvement of mature stretch marks. Pulsed dye laser, fractional laser, and special creams have shown some mild to moderate effects, but nothing, other than surgery has effectively removed stretch marks.
The most common surgery we use to improve abdominal contour and remove lower abdominal stretch marks is an abdominoplasty (tummy tuck). Liposuction alone will not improve the appearance of stretch marks and in some cases it may make the situation worse by increasing the amount of loose skin.
Hope this helps.

A study that was published in April of this year in the Journal of Plastic and Reconstructive Surgery, showed that he even mild gynecomastia (male breast tissue) can have negative effects on mental and emotional health in teenage boys.
In the study, 47 teenage boys who are being evaluated for gynecomastia took a series of psychological questionnaires. The results were compared to a group of boys without gynecomastia.
The boys with gynecomastia had lower test scores on quality of life, indicating problems in several areas. He also had lower scores in general health, social functioning and mental health even when adjusted for weight and obesity (BMI).
Lower scores in areas of self-esteem and quality of life appear to be related to gynecomastia directly, rather than obesity. These teenage boys also scored higher on a test of attitudes towards food and eating. There was no difference in the rate of eating disorders between groups.
Treatment for gynecomastia typically involves male breast reduction surgery. If your teenage boy is suffering from enlarged male breasts, please contact Dr. Bermudez for gynecomastia surgery in San Francisco today for an evaluation.
I hope this helps.

There are many factors that lead to a successful outcome in patients who undergo post-bariatric plastic surgery. Patient expectations, overall health, quality and location of the excess skin, gender, amount of weight loss, etc... If I had to pick one thing that would predict your outcome without examining you...BMI or body mass index. See link below to check yours out.
Your BMI prior to the procedures can give you a rough idea if you are a good candidate for surgery as well as your outcome.
In general, BMI >35 , in my opinion, should avoid body contouring surgery until they have reduced that number. BMI 30-35, can proceed with surgery, but will not have a fantastic result and may require additional procedures, at additional cost.
Liposuction will not reduce the amount of excess skin and has to be used cautiously in the chest and abdomen. This is where a reduction in your BMI might be more beneficial. You can't "debulk" the entire trunk with liposuction. I use it sparingly in the trunk (chest and abdomen) and more frequently in the extremities (arms and legs) as a debulking procedure.
http://nhlbisupport.com/bmi/ .

A patient came in this week with complaints of neck and shoulder pain, bra strap grooving and a rash underneath her breasts. She was a petite and 38DD. Her breasts were heavy and dense.
2 weeks ago I saw a woman who also said she was a 38DD cup, however, she had recently undergone massive weight loss (losing over 150 lbs. in 18 months) and felt that she lost shape and fullness to her breasts.
Same size, 2 very different problems.
The first patient is a classic example of someone who is a candidate for a breast reduction, which will reduce the size of her breasts and lift them to a most aesthetically pleasing shape.
The second patient needs a breast lift (mastopexy) with or without augmentation, depending on the patient’s wishes. Including an implant may improve the fullness which is lacking in many of these patients.
The best way to know whether to get a breast lift with implants, or breast reduction is to consult with a professional. Contact Dr. Bermudez, a trusted San Francisco breast surgeon today for a no-obligation consultation.

Breast implants, like all medical devices, do not last forever. The manufacturers quote anywhere from 10-15 years. Most patients will require replacement of their implants at that interval. The most common reasons to have implants exchanges are patient’s desires to change the size of their implants (usually larger), capsular contracture and/or implant leak.
Imaging studies, like MRI , can be used to detect "silent leaks" and are recommended every 3 years (FDA). Some studies have showed that high resolution ultrasound can be as effective in diagnosis of a leaking implant. At our breast health center, we routinely screen with ultrasound as it is a cheaper and easier alternative than MRI. Your medical insurance carrier may or may not cover this expense.
Saline implants do not require the regular imaging. If they leak, your body will absorb the saline (salt water) and the breast volume on that side will decrease. You'll probably figure out that you have a leak before you see your surgeon.
Both saline and silicone implants have a rubberized silicone shell. Both are prone to leak, roughly at the same rate. Silicone has a higher rate of capsular contracture than saline. We are not sure why, but probably due to the absorption of the saline....
Silicone implants feel and look better, especially in women who have very little breast tissue.
Think of the the silicone implant as a high maintenance luxury vehicle (i.e. Ferrari), where the saline is like a good solid lower maintenance luxury car (think Acura). Not as hot as the Ferrari, but still a really nice ride!
Another option for breast augmentation is fat grafting and the BRAVA device. This avoids the use of implants.
In this procedure, fat is harvested from your body and transferred to your breasts. Prior to surgery, you wear a BRAVA device to enlarge the tissue prior to grafting. You wear the BRAVA device for 2-4 weeks. The surgery is longer and requires more preoperative preparation, but if you are a candidate, can average about 250-300cc augmentation. I am currently enrolled in the FDA study.
Here are a couple of videos on the procedure:
<http://www.youtube.com/watch?v=syx1guRVfmM>
<http://www.youtube.com/watch?v=H2_cK-ddpnw>
All the best.